Swedish Medical Center is a leading specialty center for electroconvulsive therapy (ECT). Directed by Kenneth Melman, MD, the ECT Service plays an active and important role in the clinical care of many treatment refractory patients. The service treats hundreds of patients annually on an inpatient and outpatient basis, utilizing ECT for a number of psychiatric conditions. Given SMC's superior anesthesia and medical support, we serve as a tertiary referral center for seriously ill patients requiring ECT treatment.
What is Electroconvulsive Therapy?
ECT is a safe and very effective treatment for certain psychiatric disorders. ECT is most commonly used to treat patients with depression, which can be a painful and disabling illness. In addition, ECT may also be used to treat patients with psychotic or manic symptoms.
For various reasons, ECT has a social stigma attached to it. Some popular movies depicting psychiatric patients receiving ECT have created a negative public perception of this therapy. Consequently, some people react with fear when ECT is suggested as a treatment. Although ECT was introduced in the 1930's, the technique has been continuously refined and improved. As it is currently practiced, ECT may be the safest, quickest, and most effective treatment for moderate to severe depression.
How does ECT work?
During ECT, the brain is stimulated by a small amount of electrical current. The electrical current produces a modified seizure, which affects the entire brain, including centers that control mood, appetite and sleep. Researchers believe that ECT corrects the biological abnormalities that underlie severe depression. More than one treatment, however, is needed to achieve these positive effects. An average of six to ten repeated treatments (also referred to as a "series") is needed in order to achieve sustained improvement. More than 80 percent of depressed patients who receive ECT respond favorably. Following a course of treatment, patients feel more like themselves again and are able to work and lead productive lives. Often, family members, doctors, or nurses may notice improvement before the patient. After completing a successful ECT course with significant resolution of depressive symptoms, one will need to continue taking an antidepressant or receive maintenance ECT, in order to remain well.
What side effects are associated with ECT?
In general, the most common side effects are headache, muscle soreness, nausea and difficulties with short-term memory. Of these side effects, perhaps the most feared side effect is memory difficulty. Typically, mild short-term memory loss accompanies the treatment and resolves in the hours post-treatment. In rare cases, long-term memory may also be affected. If any long-term memory problems occur, they almost always resolve a few weeks after the completion of an entire course of ECT. Within a few weeks after ECT, your ability to learn and remember new information usually returns to normal.
Does ECT cause permanent brain damage?
No. This is a frequently asked question and a major concern to most patients. Studies have demonstrated that ECT does not cause brain damage, nor does it cause permanent brain dysfunction. In fact, ECT often improves the cerebral functioning of patients with severe depression. By treating the depression, patients often report that they are able to concentrate better and think more clearly. During the course of ECT, we recommend that important decisions be delayed or postponed until after recovery. If any important decisions must be made while receiving ECT, we suggest that family, friends and the treatment team be consulted.
What medical risks are associated with ECT?
As with any other medical procedure, ECT does pose some risks. Overall, ECT is one of the safest procedures done under anesthesia. Both the risks and benefits of this procedure are fully explained at the time that the patient signs a statement of informed consent. With advances in anesthesia and delivery of electricity, ECT is a safe and relatively comfortable experience.